Abstract
© 2017 Association for Child and Adolescent Mental Health.Background: Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. Methods: We conducted a systematic review with random-effects metaanalysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behavior problems among children (under 18) living in low- and middle-income countries (LMIC). Results: Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was _0.25 (95% confidence interval (CI): _0.41 to _0.09; I2: 78%) and of treatment studies was _0.56 (95% CI: _0.51 to _0.24; I2: 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: _0.35; 95% CI: _0.57 to _0.14) and behavioural parenting interventions (SMD: _0.43; 95% CI: _0.66 to _0.20), and that interventions were effective across age ranges. Conclusions: Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings.
| Original language | English |
|---|---|
| Pages (from-to) | 982-993 |
| Journal | Journal of Child Psychology and Psychiatry and Allied Disciplines |
| Volume | 59 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 6 Apr 2018 |
| Externally published | Yes |
Funding
The research reported in this publication was supported by the Johns Hopkins Clinical Research Scholars Programme (1KL2TR001077, PI: M.B.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors wish to thank Donna Hesson of the Welch Medical Library for her valuable feedback in preparing the search strategy. The authors have declared that they have no competing or potential conflicts of interest.
| Funders | Funder number |
|---|---|
| Johns Hopkins Clinical Research Scholars Programme | 1KL2TR001077 |
| National Center for Advancing Translational Sciences | KL2TR001077 |